关键词: 结核, 肺, 门诊医疗, 按诊疗收费计划, 支付标准制定和审核, 方案评价

Abstract:

Objective To analyze the outpatient treatment cost of tuberculosis (TB) patients who had not been hospitalized for the whole course of treatment under different payment models, and to provide a reference for the development of the payment policy for the financing of TB patient.Methods The data of the treatment cost of 1388 TB outpatients who completed treatment in Hanzhong designated TB hospital from January 2014 to June 2015 were collected and collated, which included 1204 cases of primary treatment and 184 cases of retreatment. The median variables (four quantiles) (M (Q₁, Q₃)) were used to describe the variables of days of medical consultation, number of visit, average cost of diagnosis and treatment per time, total cost of diagnosis and treatment, etc. Rank sum test and chi-square test were used to analyze the above variables with different treatment classification, type of health insurance, type of reimbursement and percentage of out-of-patient cost. P<0.05 was statistically significant.Results The medians of total cost of diagnosis and treatment for the primary and retreatment patients was 1580.45 Yuan (1259.70 Yuan, 2420.23 Yuan) and 1920.13 Yuan (1497.81 Yuan, 2300.44 Yuan) respectively, with statistical significance (Z=-3.267,P=0.001). The medians of average outpatient cost for single disease quota payment was 241.40 Yuan (199.21 Yuan, 358.30 Yuan), for single disease settlement according to facts was 175.00 Yuan (144.64 Yuan, 212.07 Yuan), for non-single disease payment was 140.46 Yuan (128.05 Yuan, 63.76 Yuan), and for out-of-pocket payment was 107.55 Yuan (94.71 Yuan, 136.37 Yuan), there has statistically significant difference (χ²=408.726, P=0.000). The medians of total cost for those payment models were 2054.14 Yuan (1460.23 Yuan, 2655.98 Yuan), 1342.51 Yuan (1002.25 Yuan, 1820.33 Yuan), 1018.15 Yuan (869.65 Yuan, 1321.55 Yuan) and 674.20 Yuan (495.03 Yuan, 848.07 Yuan) respectively, with statistical significance (χ²=342.875,P=0.000). 5.65% (68/1204) of primary treatment patients exceeded the outpatient quota of 3000 Yuan, and 4.35% (8/184) of re-treatment patients exceeded the quota of 4000 Yuan. The average non-service compensation was 770.00 Yuan per patient settled according to single-disease quota, and this of other models were 0. The average amount of out-of-pocket payment for the patient with single-disease payment was 409.65 Yuan (233.82 Yuan, 702.15 Yuan),with the proportion 24.84% (619580.87/2494194.76), which was lower than that of non-single disease payment patients 51.32% (8245.05/16065.98), with statistical significance (χ²=5967.453, P=0.000). The proportion of out-of-pocket payment for single-disease quota payment patients was 24.52% (441100.08/1798921.41), which was significantly lower than that of patients with single-disease settlement according to facts (χ²=355.422, P=0.000). Conclusion The quota payment for outpatient diagnosis and treatment of TB does not increase the financial burden of the hospital, and can reduce the economic burden of the patients. The outpatient diagnosis and treatment cost of TB patients should be included in the scope of the single-disease quota settlement policy and promoted, but it needs further improvement in practical application.

Key words: Tuberculosis, pulmonary, Ambulatory care, Fee-for-service plans, Rate setting and review, Program evaluation